December 29, 2025 • 28 mins
This week, we take a look at the biggest moments of 2025 and the watchpoints for 2026. We’ll be discussing the trends that shaped politics, international affairs, sports, technology, and health.
In this episode, we're joined by The Indian Express' Anonna Dutt to discuss the field of health and medicine, where the conversation over the past year has been shaped by a few recurring developments: weight-loss drugs, policy push toward the use of AI in healthcare and the state of air pollution.
Hosted by Ichha Sharma
Produced and written by Shashank Bhargava and Ichha Sharma
Edited and mixed by Suresh Pawar
In this episode, we're joined by The Indian Express' Anonna Dutt to discuss the field of health and medicine, where the conversation over the past year has been shaped by a few recurring developments: weight-loss drugs, policy push toward the use of AI in healthcare and the state of air pollution.
Hosted by Ichha Sharma
Produced and written by Shashank Bhargava and Ichha Sharma
Edited and mixed by Suresh Pawar
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hi a Micha Sharma and you're listening to Three Things
the Indian Express New show. This week, on the show,
we are looking back at some of the biggest moments
of twenty twenty five. Yesterday we discuss the key events
that shaped cinema and OTT this year with The Indian
Express's film critic Shudragupta. And today we turn our attention
(00:27):
to the field of health and medicine, where the conversation
over the past year has been shaped by a few
recurring developments. The weight loss drugs, originally designed for diabetes,
became a major topic of discussion, while India's health system
saw a stronger policy pushed towards the use of AI
and at the same time, air pollution remained a persistent
(00:48):
and pressing public health concern throughout the year. And sort
of break down these trends, we're joined by the Indian
Expresses anonadad An. A lot has happened this year in
the health sector and one of the major highlights is
the WHO issuing its first guidelines on weight loss drugs,
explicitly treating obesity as a chronic, relapsing disease and also
(01:11):
stressing on the long term care for it. So tell
our listeners that does calling obesity a chronic disease actually
change anything on the ground or moving into the next year,
we still just treat it as a lifestyle condition in India.
Speaker 2 (01:26):
So this definition of being a chronic condition chronic relapsing
condition sort of changes the way we treat obesity. So
so far, most of the people saw obesity as just
a cosmetic problem, so to say, and even the bariatric surgeries, etc.
Were seen by people as a cosmetic procedure. Although you know,
(01:50):
if you talk to the doctors, they would say that
it is done to sort of provide relief to people
who are morbidly obese, people who have conditions like diabetes,
high pretension, heart disease, et cetera because of this underlying obacity,
and who actually improve when this obacity is taken care of.
So this is sort of like a change in viewpoint.
(02:11):
But what it also promotes is a change in health
systems management of ovacity. So if you look at something
like diabetes or hypertension, which are known chronic conditions for
which you know, people take lifelong medicines and they have
to do these lifestyle interventions like exercising enough eating healthy food.
(02:34):
All of this advice and treatment is right now offered
at the lowest level of health care facilities. So even
at say a subcenter or a primary health center, a
person can be diagnosed for and treated for something like
diabetes and hypertension, but that is not true of obesity.
(02:54):
While the doctors will give you advice on losing weight.
What this definition promotes is a comprehensive care being available
at all levels of healthcare services. So that would include
of course counseling on what needs to be done in
terms of lifestyle change, counseling with a dietitian to understand
(03:15):
how you can you know, easily modify your diet in
a way that you lose weight, but that will also
come with the drugs or you know, interventions such as
bariatric surgery. So there is a push with these wh
your guidelines towards creating an ecosystem where again obesity as
a disease can be managed throughout and like you know,
(03:38):
there is a constant, say follow up like you would
do with say a diabetes or a hypertension patient.
Speaker 1 (03:45):
And for those who may not know, could you tell
us which weight loss drugs are currently available in the
country and also how they differ from each other.
Speaker 2 (03:53):
So this year has been exciting for India when it
comes to weight loss. Both of the major molecules for
weight lass which have been available across the world for
the last four or five years or so, have now
become available in India. So earlier this year, Alilily introduced
its molecule turzepetide and Novo Nordisk also introduced its semiglutide,
(04:16):
which other two most popular weight loss drugs available across
the world. They have also launched various versions of these drugs,
so for example the easy injectible pens. There's also the
recent launch of the diabetes dose of the injectable drug.
And what we have seen is a rapid growth in
(04:39):
the market of these anti obasity drugs, especially when we
look at the market share of ze Petite, which is
by Alilily. So there has been a massive growth and
of course the impact of this we will see in
the next few years. But definitely people have started taking
these medicines, which has already happened opened in countries such
(05:01):
as the US and Anon.
Speaker 1 (05:03):
Approximately how much do these drugs cost in India.
Speaker 2 (05:07):
So when it comes to India, the price of these
medicines semaglutide. The highest dose for semaglutide is around say
sixteen thousand to seventeen thousand rupees per month and the
lowest is about ten to eleven thousand. This is after
the price drop that we spoke about. So when it
comes to tursupetide also the price is about similar. It
(05:30):
ranges from say fourteen thousand a month to seventeen thousand
month for the lowest to the highest dose of the drug.
Speaker 1 (05:40):
And we understand that in India doctors have been raising
concerns about casual use and the growing cosmetic demand for
these drugs. So who is this drug really meant for
and who should be staying away from it?
Speaker 2 (05:54):
So if you see in the latest DLP one drugs
starting with semaglutide was actually in actually meant for the
treatment of only type two diabetes, but people started using
it off label because of the weight loss potential of
the drug, which is you know, some people losing even
up to twenty twenty five percent of the body weight,
(06:15):
which is similar to what you would see with the
bariatric surgery. So that itself sort of perpetuated this cosmetic
use of these drugs, which is something that should not
be done. These are medicines which are meant to help,
especially people who are obese with various conditions for which
(06:37):
obesity is a risk factor as well as you know
they've reached a plateau. So this is not the first
line of care that a doctor would ever prescribe. The
doctors would essentially motivate the patients, so to say, to
initially have some lifestyle changes, some dietary changes, and when
they are able to stick to that, and even with that,
(07:00):
if they are not able to lose significant weight, that
is when these medicines are added on for weight loss.
So it is a challenge. And now that the drugs
are available in the country, there is likely to be
this cosmetic use of the drugs. But essentially it is
meant only for people with very high BMI or people
(07:23):
with high BMI and you know, conditions like diabetes, hypertension,
heart disease, things like that, So it is not meant
for everybody, especially not for cosmetic use.
Speaker 1 (07:37):
And don't know, a lot of patients are anxious about
taking these drugs indefinitely, So talk about what happens if
someone stops taking these drugs.
Speaker 2 (07:47):
So the evidence so far that we have, and this
is years of evidence that we have, especially with semaglutide,
which was a molecule that entered the market before. What
we see is that once you stop taking the medicine
there is an increase in body weight. So people do
bounce back, like with any other obesity measure. So even
(08:11):
if you go on a diet and if you then
stop following the diet, there is a reuptake of the weight. However,
so far, what they've shown is it's not as much
as the weight at the starting point. But now there
are certain gaps which has also been identified by this
WHO guideline which needs to be addressed, which is like
(08:32):
finding out whether the doors can be tapered off. Like
with certain medications, you would see that once an acute
thing has been taken care of, you slowly reduce the
doors and people stop the medicine. So whether that is
possible with the drugs, whether there could be a lower
dose on which people can maintain their weight while not
(08:52):
taking very high doses of the medicines, all of these
questions need to be answered. But also what a lot
of clinicians would say that it is like any chronic condition,
for example, hypertension or diabetes, in which you would actually
keep taking your medicine life long once you have the condition.
So many do see it that way, but there are
(09:15):
still studies going on to figure out what sort of
dose can be given, whether these medicines can be stopped altogether,
whether there should be a lower dose given. All of
this is being studied at the moment.
Speaker 1 (09:27):
And another sticking point for these drugs is the cost.
Right though recently Vigovi became much cheaper in India as
competition from Munjaro picked up. But moving into twenty twenty six,
what changes will matter the most for these drugs like accessibility,
tighter regulations or something else.
Speaker 2 (09:45):
So till twenty twenty five, one of the biggest challenges
was getting the drug itself, as it was not available
in India, so people would usually go to you know,
other countries. People would travel to, say Dubai and get
the drugs. This was happening before twenty twenty five when
the drugs were finally introduced in the Indian market. Now
the challenge, of course remains the cost, and the companies
(10:07):
have actually worked towards reducing the costs For example, Novo
Nordisk actually partnered with another country to produce the same
drug and cut the cost by say, I think it
was around thirty three percent or so. So the companies
themselves have reduced the cost. But the big thing that
will happen going into twenty twenty six is that Sema
(10:29):
glutype patent is going to come to an end and
that would likely open markets for other companies to manufacture
these GLP one drugs. What we have seen so far
with other diabetes medicines is as soon as these medicines
go off patent, generic versions become available in India, and
the generic versions cost you know, as little as ten
(10:52):
percent of the cost of the patented medicine. So we
are likely to see cheaper versions of these medicines of
Sema blue tight becoming available likely next year, which will
in itself increase the access to the medicines much more.
Speaker 1 (11:07):
Alanora. Another interesting highlight this year was that the Health
Ministry's researching got a multi year enhancement plan explicitly naming
AI in healthcare.
Speaker 2 (11:18):
So how should we interpret this funding push? So there
has definitely been pushed towards AI to solve gaps in
the system when it comes to healthcare delivery. This year,
there has been a systematic development across the major health institutes.
Take for example AIMS Delhi and other places which have
(11:41):
developed AI solutions that can be added on to the
government programs for various diseases. So we spoke about different
government programs. One would of course be the tuberculosis program
of the government, which is a key program considering the
aim was to eliminate the disease this year in twenty
(12:03):
twenty five, they've added a couple of either they've added
or in the process of adding AI solutions to the
program right now.
Speaker 1 (12:11):
And even during your reportage, you highlight how AI screening
improved tbk's detection and say, even in regard with cancer,
we keep hearing that AI will help with screening, radiology,
pathology backlogs. So where across the treatment process can AI
really make a difference.
Speaker 2 (12:29):
So one is the AI based handheld X ray devices.
So essentially what happens with tuberculosis is that even before
say a person developed symptoms such as coughing, tb can
be seen in their lungs in an X ray. So
the government actually started including these small X ray devices
(12:49):
which look sort of like digital camera which can be
used to take X rays in a PC or even
more remote setting, probably even in the community. These machines
can generate a digital X ray within seconds, and these
devices also come with an AI system along with it
which can give you a probable diagnosis of TB within seconds.
(13:14):
So that would mean that the technician would be able
to tell a person that they might have TB within
seconds and then they would refer them to the higher
center to get a confirmatory molecular testing done. So this
is a great way of finding cases actively, especially cases
which might not even show symptoms. The second innovation is
(13:36):
something called Cough against TB. This is also to reach
the last mile and to detect more and more TB
cases with the least amount of save resources being utilized.
So what can be done with this app is that
any healthcare worker Ashadda and m whoever is visiting the
houses of people can ask those with t BE like
(14:00):
symptoms to record their cough and this small recording can
be put on this AI platform which has analyzed, you know,
several sounds of cough of the TV patients and can
again tell that this person is probably TB positive or
they are likely to be TV negative. You know, this
(14:21):
coff against TB led to a thirteen percent increase in
the number of TB cases being detected. And when it
comes to the X ray devices, it was utilized during
this one hundred day campaign that the government had launched
last year in December. So in that campaign itself, they
(14:42):
were able to find two point eighty five lack additional
cases with no symptoms. So that is the impact of
these AI tools.
Speaker 1 (14:51):
And you also highlight how there have been efforts to
strengthen health information systems for clinical decision making. So how
does AI help there?
Speaker 2 (15:01):
So there is something called the Clinical Decision Support System
which is essentially a plugin into the government's telemedicine platform
called e Sanjivni and it actually guides the doctors at
a higher center to reach the correct diagnosis quicker. So essentially,
the AI model is actually based on the data that
(15:23):
has been collected from this telemedicine service itself. The initial
few lacks of patients who were seen. Their data was
utilized to develop and train this model and now it
can recognize around three hundred symptoms of the most common
diseases that are seen on the platform such as you know,
respiratory in fictions, gastritis, fever, diabetes, et cetera. And once
(15:49):
the patient symptoms are put in and certain additional details
like what was the duration of the symptoms, what was
the severity, the location of the symptoms, and of course
the patient detail is like their age, gender, etc. Once
all of this information is put on the system, it
actually gives the physicians who are remotely located. So the
(16:09):
EASMNGVNI actually facilitates communication with the specialists who are in
like super specialty centers or tertiary care hospitals of the
government to the primary health center. So the details are
to be filled by the doctors or health staff from
the primary health center and the doctors in the medical
colleges and tertiary care centers can use the details to
(16:33):
give the diagnosis. And this clinical decision support system actually
helps by giving three most probable diagnoses, so it sort
of reduces the burden on the doctor.
Speaker 1 (16:44):
And an only another interesting use case of AI that
you highlight is early outbreak detection for infectious diseases like
COVID or GBS, you know, helping analyze spread patterns and
also identifying higher sk careers, So could I talk a
bit about that.
Speaker 2 (17:02):
So one of the key ways in which the government's
surveillance mechanism used to pick up on, you know, these
unusual clusters of symptoms, et cetera, would be by going
through local newspapers. That is a time consuming task however,
so now they have developed an AI which can scan
several newspapers in thirteen different languages to actually raise such
(17:27):
health alerts. And you know, initially it would also raise
alerts for symptoms like you know, people getting into accidents,
et cetera. But over time it has realized what kind
of symptoms the surveillance team is looking for and it
raises these alerts which are then investigated by the local
surveillance teams. There is also another example of AI being
(17:49):
used is the AI enabled Fundas camera. It's the camera
you know, which is used to take the image of
the retina, but this one is enabled with AI, which
means the image can be interpreted on its own by
the model instead of the requirement for a technician or
a physician to be present right there. So this again
(18:11):
has been done to plug the gap of availability of
trained staff as well as availability of these fundesst cameras
in several remote places. While the government has been over
the years, you know, increasing the number of these cameras
available in primary health centers. This is just an addition
(18:32):
to that, and the AI model can be plugged into
any of the cameras that may have already been there
in the health system. Now why is this essential because
this camera can detect diabetic retinopathy, you know, screen the
diabetes patients for it and detect it quickly.
Speaker 1 (18:49):
I don't know. For those who may not know, could
you tell us what is diabetic retinopathy.
Speaker 2 (18:54):
Diabetic retinopathy is essentially a condition where you know, high
blood sugar over years damages the blood vessels in the
retina of the eye and it can lead to a
complete vision loss. The challenge is there is no symptoms
as such that people feel before they start losing their vision,
so usually people would come to a doctor only once
(19:17):
they have started losing their vision or they have lost
their vision. And in this case, you know, there are
ways to sort of stall the damage to the retina,
but there are no ways to reverse the damage once
it's been done, and which is where this AI enabled
camera would be very helpful.
Speaker 1 (19:36):
And now moving away from AI. Another point of discussion
this year was how India's target of eliminating TB by
twenty twenty five was not meant So why was that
and also was this an unrealistic target?
Speaker 2 (19:51):
So basically the international goal of eliminating TB was for
twenty thirty. However India committed to do so that five
years ahead of the target in twenty twenty five. This
was a challenging goal to begin with. Of course, this
declaration and the announcement by PMO the at an international
(20:13):
stage meant that there was a lot more commitment towards it,
a lot more money came into the program. You know,
the things were being implemented in a mission mode. But
it was a very very difficult target to begin with.
And then COVID further complicated the matter because the detection
of TB cases actually went down during the COVID period,
(20:36):
and of course it has bounced back and now we
detect far more TB cases than we used to before COVID,
but there was a dip for a couple of years,
and that does have an impact because if patients are
not detected, then they further spread the infection, so that
meant that twenty twenty five started looking much more unrealistic. However,
(20:57):
it has been a good commitment because it has brought
in more steam to the program, and so I don't.
Speaker 1 (21:04):
Have given the push for the program. Is it safe
to assume that this target could be achieved in twenty thirty?
Speaker 2 (21:11):
I mean, of course, we do not have the figures
yet for this year, but in twenty twenty four we
detected twenty seven point one lack cases and from what
I hear from experts who have been working with the program,
we are about to detect a similar number of cases
in twenty twenty five as well. So elimination is not
a possibility yet. And we do not have another fixed target,
(21:35):
say for twenty thirty as well. We've not declared it officially,
but there is a lot of effort that is happening
now to sort of bridge the gap. Over the last
couple of years, the number of cases being detected has
increased significantly. So there are two numbers that we usually
see in these annual TV reports. One is the estimated
(21:57):
number of cases. There is a methodology and you know,
there's a modeling which predicts the number of cases that
are likely to happen each year in each country. And
the second number is the reported number of cases, which
is the number of cases that have actually been detected,
tested positive and are now registered in the national program.
(22:19):
So I think now come to a point where we're
detecting almost all of the cases that are estimated. So
this year the gap between the estimated case and the
detected cases was just about one lack. And when I
said just about one lack, that's because say, I think
ten fifteen years back, that gap was about fifteen lacks.
(22:39):
So we have significantly reduced that gap, which means we
are detecting more cases and they're unlikely to spread the
disease further. There has also been an increase in the
coverage of TB treatment is what we've seen, and like
I mentioned in the previous segment, there is also a
push towards a lot of these innovations coming into the program.
(23:02):
So all of this is likely to go a long
way towards probably ending TB by twenty thirty, but there
have also been challenges. For example, last year there was
a stockout of even the commonly used medicines for the
treatment of TB. So we are looking at the positives
(23:22):
as well as the challenges that have happened. But yes,
there is a lot of work that is happening now
towards this goal of elimination.
Speaker 1 (23:31):
Right. And of course, when talking about health, we cannot
not discuss how thirteen of the world's twenty most polluted
cities are in India. And you know, when people hear
that AQI is bad, it can still feel a bit vague.
So what's the clearest way to explain what pollution does
to the body, especially the long term exposure to it.
Speaker 2 (23:54):
Right, So when we talk about pollution, it's not just
the immediate effel such as you know, some people facing
breathing difficulty, some people having you know, teary eyes because
of the irritation, or some people also have skin conditions
that get flared up. All of this happens. Yes, these
(24:15):
are the acute changes that happen in the immediate term,
days after there is a spike in the pollution levels.
But what is more concerning is that we see that
the air pollution and over the years the exposure to
it can actually impact every system in the body. It's
(24:35):
not just the lungs. It can have an effect on everything,
including your brain, including conditions like diabetes. It does impact
the children as well, so there is enough research to
now suggest that you know, high air pollution levels can
lead to premature babies. It can lead to development delays
in babies. There is also some links between certain brain
(25:00):
conditions and pollution. Of course, the lungs are severely affected
with pollution. It can lead to conditions such as COPD.
There is an increase in asthma as well. There is
also an impact on heart conditions, so for example, we
know that increased level of pollution can also increase the hypertension,
(25:23):
so your blood pressure levels, it can increase, so the
control of diabetes goes down with the air pollution. There
are other systemic changes. It affects the hearts. It also
causes a lot of infections because it sort of impacts
the immunity of the body. So air pollution is not
an isolated thing which leads to just some acute symptoms.
(25:46):
It can have a chronic impact over the entire lifetime
of a person, right from the time when they are
in the womb, so it is a very very serious condition.
Speaker 1 (25:59):
And lastly, Anona, as you mentioned, we still see pollution
as a seasonal inconvenience. So what would you lay down
as your non negotiables for twenty twenty six On air pollution.
Speaker 2 (26:11):
So, of course when we talk about air pollution, the
highlight of it comes in the national capital, which sees
one of the worst air pollutions, and of course the
entire of the gangetic planes is where we see very
bad air pollution levels during these months. What is needed is,
of course there's a national clean air plan and whatever,
(26:32):
but there has to be implementation of it, like when
we talk about Deli, looking at what are the sources
of pollution, and it cannot just be the you know,
par aali burning. That's not the entire reason for the
bad air in the region. It is also the amount
of vehicular emissions that we have, the construction that we have,
(26:53):
So just you know, taking a look at what is
causing the pollution and developing a plan to bring down
the pollution levels over the years, and not a short
term plan to sort of mitigate. See the GRAP being
implemented is a very short term measure to help people
when the pollution level spike, but that is not something
(27:16):
that can take care of the actual reasons why this
becomes a problem. Every year. That has to be addressed
in a systematic plan over the years, and we need
to work on that.
Speaker 1 (27:32):
You were listening to Three Things by the Indian Express.
Today's show was edited and mixed by Savar and produced
by Shishang Hagov and me At Shasharma. If you like
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You can also recommend it to someone you think may
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(27:55):
or write to us at podcast at Indian Express dot com.
Speaker 2 (28:00):
M
Hi a Micha Sharma and you're listening to Three Things
the Indian Express New show. This week, on the show,
we are looking back at some of the biggest moments
of twenty twenty five. Yesterday we discuss the key events
that shaped cinema and OTT this year with The Indian
Express's film critic Shudragupta. And today we turn our attention
(00:27):
to the field of health and medicine, where the conversation
over the past year has been shaped by a few
recurring developments. The weight loss drugs, originally designed for diabetes,
became a major topic of discussion, while India's health system
saw a stronger policy pushed towards the use of AI
and at the same time, air pollution remained a persistent
(00:48):
and pressing public health concern throughout the year. And sort
of break down these trends, we're joined by the Indian
Expresses anonadad An. A lot has happened this year in
the health sector and one of the major highlights is
the WHO issuing its first guidelines on weight loss drugs,
explicitly treating obesity as a chronic, relapsing disease and also
(01:11):
stressing on the long term care for it. So tell
our listeners that does calling obesity a chronic disease actually
change anything on the ground or moving into the next year,
we still just treat it as a lifestyle condition in India.
Speaker 2 (01:26):
So this definition of being a chronic condition chronic relapsing
condition sort of changes the way we treat obesity. So
so far, most of the people saw obesity as just
a cosmetic problem, so to say, and even the bariatric surgeries, etc.
Were seen by people as a cosmetic procedure. Although you know,
(01:50):
if you talk to the doctors, they would say that
it is done to sort of provide relief to people
who are morbidly obese, people who have conditions like diabetes,
high pretension, heart disease, et cetera because of this underlying obacity,
and who actually improve when this obacity is taken care of.
So this is sort of like a change in viewpoint.
(02:11):
But what it also promotes is a change in health
systems management of ovacity. So if you look at something
like diabetes or hypertension, which are known chronic conditions for
which you know, people take lifelong medicines and they have
to do these lifestyle interventions like exercising enough eating healthy food.
(02:34):
All of this advice and treatment is right now offered
at the lowest level of health care facilities. So even
at say a subcenter or a primary health center, a
person can be diagnosed for and treated for something like
diabetes and hypertension, but that is not true of obesity.
(02:54):
While the doctors will give you advice on losing weight.
What this definition promotes is a comprehensive care being available
at all levels of healthcare services. So that would include
of course counseling on what needs to be done in
terms of lifestyle change, counseling with a dietitian to understand
(03:15):
how you can you know, easily modify your diet in
a way that you lose weight, but that will also
come with the drugs or you know, interventions such as
bariatric surgery. So there is a push with these wh
your guidelines towards creating an ecosystem where again obesity as
a disease can be managed throughout and like you know,
(03:38):
there is a constant, say follow up like you would
do with say a diabetes or a hypertension patient.
Speaker 1 (03:45):
And for those who may not know, could you tell
us which weight loss drugs are currently available in the
country and also how they differ from each other.
Speaker 2 (03:53):
So this year has been exciting for India when it
comes to weight loss. Both of the major molecules for
weight lass which have been available across the world for
the last four or five years or so, have now
become available in India. So earlier this year, Alilily introduced
its molecule turzepetide and Novo Nordisk also introduced its semiglutide,
(04:16):
which other two most popular weight loss drugs available across
the world. They have also launched various versions of these drugs,
so for example the easy injectible pens. There's also the
recent launch of the diabetes dose of the injectable drug.
And what we have seen is a rapid growth in
(04:39):
the market of these anti obasity drugs, especially when we
look at the market share of ze Petite, which is
by Alilily. So there has been a massive growth and
of course the impact of this we will see in
the next few years. But definitely people have started taking
these medicines, which has already happened opened in countries such
(05:01):
as the US and Anon.
Speaker 1 (05:03):
Approximately how much do these drugs cost in India.
Speaker 2 (05:07):
So when it comes to India, the price of these
medicines semaglutide. The highest dose for semaglutide is around say
sixteen thousand to seventeen thousand rupees per month and the
lowest is about ten to eleven thousand. This is after
the price drop that we spoke about. So when it
comes to tursupetide also the price is about similar. It
(05:30):
ranges from say fourteen thousand a month to seventeen thousand
month for the lowest to the highest dose of the drug.
Speaker 1 (05:40):
And we understand that in India doctors have been raising
concerns about casual use and the growing cosmetic demand for
these drugs. So who is this drug really meant for
and who should be staying away from it?
Speaker 2 (05:54):
So if you see in the latest DLP one drugs
starting with semaglutide was actually in actually meant for the
treatment of only type two diabetes, but people started using
it off label because of the weight loss potential of
the drug, which is you know, some people losing even
up to twenty twenty five percent of the body weight,
(06:15):
which is similar to what you would see with the
bariatric surgery. So that itself sort of perpetuated this cosmetic
use of these drugs, which is something that should not
be done. These are medicines which are meant to help,
especially people who are obese with various conditions for which
(06:37):
obesity is a risk factor as well as you know
they've reached a plateau. So this is not the first
line of care that a doctor would ever prescribe. The
doctors would essentially motivate the patients, so to say, to
initially have some lifestyle changes, some dietary changes, and when
they are able to stick to that, and even with that,
(07:00):
if they are not able to lose significant weight, that
is when these medicines are added on for weight loss.
So it is a challenge. And now that the drugs
are available in the country, there is likely to be
this cosmetic use of the drugs. But essentially it is
meant only for people with very high BMI or people
(07:23):
with high BMI and you know, conditions like diabetes, hypertension,
heart disease, things like that, So it is not meant
for everybody, especially not for cosmetic use.
Speaker 1 (07:37):
And don't know, a lot of patients are anxious about
taking these drugs indefinitely, So talk about what happens if
someone stops taking these drugs.
Speaker 2 (07:47):
So the evidence so far that we have, and this
is years of evidence that we have, especially with semaglutide,
which was a molecule that entered the market before. What
we see is that once you stop taking the medicine
there is an increase in body weight. So people do
bounce back, like with any other obesity measure. So even
(08:11):
if you go on a diet and if you then
stop following the diet, there is a reuptake of the weight. However,
so far, what they've shown is it's not as much
as the weight at the starting point. But now there
are certain gaps which has also been identified by this
WHO guideline which needs to be addressed, which is like
(08:32):
finding out whether the doors can be tapered off. Like
with certain medications, you would see that once an acute
thing has been taken care of, you slowly reduce the
doors and people stop the medicine. So whether that is
possible with the drugs, whether there could be a lower
dose on which people can maintain their weight while not
(08:52):
taking very high doses of the medicines, all of these
questions need to be answered. But also what a lot
of clinicians would say that it is like any chronic condition,
for example, hypertension or diabetes, in which you would actually
keep taking your medicine life long once you have the condition.
So many do see it that way, but there are
(09:15):
still studies going on to figure out what sort of
dose can be given, whether these medicines can be stopped altogether,
whether there should be a lower dose given. All of
this is being studied at the moment.
Speaker 1 (09:27):
And another sticking point for these drugs is the cost.
Right though recently Vigovi became much cheaper in India as
competition from Munjaro picked up. But moving into twenty twenty six,
what changes will matter the most for these drugs like accessibility,
tighter regulations or something else.
Speaker 2 (09:45):
So till twenty twenty five, one of the biggest challenges
was getting the drug itself, as it was not available
in India, so people would usually go to you know,
other countries. People would travel to, say Dubai and get
the drugs. This was happening before twenty twenty five when
the drugs were finally introduced in the Indian market. Now
the challenge, of course remains the cost, and the companies
(10:07):
have actually worked towards reducing the costs For example, Novo
Nordisk actually partnered with another country to produce the same
drug and cut the cost by say, I think it
was around thirty three percent or so. So the companies
themselves have reduced the cost. But the big thing that
will happen going into twenty twenty six is that Sema
(10:29):
glutype patent is going to come to an end and
that would likely open markets for other companies to manufacture
these GLP one drugs. What we have seen so far
with other diabetes medicines is as soon as these medicines
go off patent, generic versions become available in India, and
the generic versions cost you know, as little as ten
(10:52):
percent of the cost of the patented medicine. So we
are likely to see cheaper versions of these medicines of
Sema blue tight becoming available likely next year, which will
in itself increase the access to the medicines much more.
Speaker 1 (11:07):
Alanora. Another interesting highlight this year was that the Health
Ministry's researching got a multi year enhancement plan explicitly naming
AI in healthcare.
Speaker 2 (11:18):
So how should we interpret this funding push? So there
has definitely been pushed towards AI to solve gaps in
the system when it comes to healthcare delivery. This year,
there has been a systematic development across the major health institutes.
Take for example AIMS Delhi and other places which have
(11:41):
developed AI solutions that can be added on to the
government programs for various diseases. So we spoke about different
government programs. One would of course be the tuberculosis program
of the government, which is a key program considering the
aim was to eliminate the disease this year in twenty
(12:03):
twenty five, they've added a couple of either they've added
or in the process of adding AI solutions to the
program right now.
Speaker 1 (12:11):
And even during your reportage, you highlight how AI screening
improved tbk's detection and say, even in regard with cancer,
we keep hearing that AI will help with screening, radiology,
pathology backlogs. So where across the treatment process can AI
really make a difference.
Speaker 2 (12:29):
So one is the AI based handheld X ray devices.
So essentially what happens with tuberculosis is that even before
say a person developed symptoms such as coughing, tb can
be seen in their lungs in an X ray. So
the government actually started including these small X ray devices
(12:49):
which look sort of like digital camera which can be
used to take X rays in a PC or even
more remote setting, probably even in the community. These machines
can generate a digital X ray within seconds, and these
devices also come with an AI system along with it
which can give you a probable diagnosis of TB within seconds.
(13:14):
So that would mean that the technician would be able
to tell a person that they might have TB within
seconds and then they would refer them to the higher
center to get a confirmatory molecular testing done. So this
is a great way of finding cases actively, especially cases
which might not even show symptoms. The second innovation is
(13:36):
something called Cough against TB. This is also to reach
the last mile and to detect more and more TB
cases with the least amount of save resources being utilized.
So what can be done with this app is that
any healthcare worker Ashadda and m whoever is visiting the
houses of people can ask those with t BE like
(14:00):
symptoms to record their cough and this small recording can
be put on this AI platform which has analyzed, you know,
several sounds of cough of the TV patients and can
again tell that this person is probably TB positive or
they are likely to be TV negative. You know, this
(14:21):
coff against TB led to a thirteen percent increase in
the number of TB cases being detected. And when it
comes to the X ray devices, it was utilized during
this one hundred day campaign that the government had launched
last year in December. So in that campaign itself, they
(14:42):
were able to find two point eighty five lack additional
cases with no symptoms. So that is the impact of
these AI tools.
Speaker 1 (14:51):
And you also highlight how there have been efforts to
strengthen health information systems for clinical decision making. So how
does AI help there?
Speaker 2 (15:01):
So there is something called the Clinical Decision Support System
which is essentially a plugin into the government's telemedicine platform
called e Sanjivni and it actually guides the doctors at
a higher center to reach the correct diagnosis quicker. So essentially,
the AI model is actually based on the data that
(15:23):
has been collected from this telemedicine service itself. The initial
few lacks of patients who were seen. Their data was
utilized to develop and train this model and now it
can recognize around three hundred symptoms of the most common
diseases that are seen on the platform such as you know,
respiratory in fictions, gastritis, fever, diabetes, et cetera. And once
(15:49):
the patient symptoms are put in and certain additional details
like what was the duration of the symptoms, what was
the severity, the location of the symptoms, and of course
the patient detail is like their age, gender, etc. Once
all of this information is put on the system, it
actually gives the physicians who are remotely located. So the
(16:09):
EASMNGVNI actually facilitates communication with the specialists who are in
like super specialty centers or tertiary care hospitals of the
government to the primary health center. So the details are
to be filled by the doctors or health staff from
the primary health center and the doctors in the medical
colleges and tertiary care centers can use the details to
(16:33):
give the diagnosis. And this clinical decision support system actually
helps by giving three most probable diagnoses, so it sort
of reduces the burden on the doctor.
Speaker 1 (16:44):
And an only another interesting use case of AI that
you highlight is early outbreak detection for infectious diseases like
COVID or GBS, you know, helping analyze spread patterns and
also identifying higher sk careers, So could I talk a
bit about that.
Speaker 2 (17:02):
So one of the key ways in which the government's
surveillance mechanism used to pick up on, you know, these
unusual clusters of symptoms, et cetera, would be by going
through local newspapers. That is a time consuming task however,
so now they have developed an AI which can scan
several newspapers in thirteen different languages to actually raise such
(17:27):
health alerts. And you know, initially it would also raise
alerts for symptoms like you know, people getting into accidents,
et cetera. But over time it has realized what kind
of symptoms the surveillance team is looking for and it
raises these alerts which are then investigated by the local
surveillance teams. There is also another example of AI being
(17:49):
used is the AI enabled Fundas camera. It's the camera
you know, which is used to take the image of
the retina, but this one is enabled with AI, which
means the image can be interpreted on its own by
the model instead of the requirement for a technician or
a physician to be present right there. So this again
(18:11):
has been done to plug the gap of availability of
trained staff as well as availability of these fundesst cameras
in several remote places. While the government has been over
the years, you know, increasing the number of these cameras
available in primary health centers. This is just an addition
(18:32):
to that, and the AI model can be plugged into
any of the cameras that may have already been there
in the health system. Now why is this essential because
this camera can detect diabetic retinopathy, you know, screen the
diabetes patients for it and detect it quickly.
Speaker 1 (18:49):
I don't know. For those who may not know, could
you tell us what is diabetic retinopathy.
Speaker 2 (18:54):
Diabetic retinopathy is essentially a condition where you know, high
blood sugar over years damages the blood vessels in the
retina of the eye and it can lead to a
complete vision loss. The challenge is there is no symptoms
as such that people feel before they start losing their vision,
so usually people would come to a doctor only once
(19:17):
they have started losing their vision or they have lost
their vision. And in this case, you know, there are
ways to sort of stall the damage to the retina,
but there are no ways to reverse the damage once
it's been done, and which is where this AI enabled
camera would be very helpful.
Speaker 1 (19:36):
And now moving away from AI. Another point of discussion
this year was how India's target of eliminating TB by
twenty twenty five was not meant So why was that
and also was this an unrealistic target?
Speaker 2 (19:51):
So basically the international goal of eliminating TB was for
twenty thirty. However India committed to do so that five
years ahead of the target in twenty twenty five. This
was a challenging goal to begin with. Of course, this
declaration and the announcement by PMO the at an international
(20:13):
stage meant that there was a lot more commitment towards it,
a lot more money came into the program. You know,
the things were being implemented in a mission mode. But
it was a very very difficult target to begin with.
And then COVID further complicated the matter because the detection
of TB cases actually went down during the COVID period,
(20:36):
and of course it has bounced back and now we
detect far more TB cases than we used to before COVID,
but there was a dip for a couple of years,
and that does have an impact because if patients are
not detected, then they further spread the infection, so that
meant that twenty twenty five started looking much more unrealistic. However,
(20:57):
it has been a good commitment because it has brought
in more steam to the program, and so I don't.
Speaker 1 (21:04):
Have given the push for the program. Is it safe
to assume that this target could be achieved in twenty thirty?
Speaker 2 (21:11):
I mean, of course, we do not have the figures
yet for this year, but in twenty twenty four we
detected twenty seven point one lack cases and from what
I hear from experts who have been working with the program,
we are about to detect a similar number of cases
in twenty twenty five as well. So elimination is not
a possibility yet. And we do not have another fixed target,
(21:35):
say for twenty thirty as well. We've not declared it officially,
but there is a lot of effort that is happening
now to sort of bridge the gap. Over the last
couple of years, the number of cases being detected has
increased significantly. So there are two numbers that we usually
see in these annual TV reports. One is the estimated
(21:57):
number of cases. There is a methodology and you know,
there's a modeling which predicts the number of cases that
are likely to happen each year in each country. And
the second number is the reported number of cases, which
is the number of cases that have actually been detected,
tested positive and are now registered in the national program.
(22:19):
So I think now come to a point where we're
detecting almost all of the cases that are estimated. So
this year the gap between the estimated case and the
detected cases was just about one lack. And when I
said just about one lack, that's because say, I think
ten fifteen years back, that gap was about fifteen lacks.
(22:39):
So we have significantly reduced that gap, which means we
are detecting more cases and they're unlikely to spread the
disease further. There has also been an increase in the
coverage of TB treatment is what we've seen, and like
I mentioned in the previous segment, there is also a
push towards a lot of these innovations coming into the program.
(23:02):
So all of this is likely to go a long
way towards probably ending TB by twenty thirty, but there
have also been challenges. For example, last year there was
a stockout of even the commonly used medicines for the
treatment of TB. So we are looking at the positives
(23:22):
as well as the challenges that have happened. But yes,
there is a lot of work that is happening now
towards this goal of elimination.
Speaker 1 (23:31):
Right. And of course, when talking about health, we cannot
not discuss how thirteen of the world's twenty most polluted
cities are in India. And you know, when people hear
that AQI is bad, it can still feel a bit vague.
So what's the clearest way to explain what pollution does
to the body, especially the long term exposure to it.
Speaker 2 (23:54):
Right, So when we talk about pollution, it's not just
the immediate effel such as you know, some people facing
breathing difficulty, some people having you know, teary eyes because
of the irritation, or some people also have skin conditions
that get flared up. All of this happens. Yes, these
(24:15):
are the acute changes that happen in the immediate term,
days after there is a spike in the pollution levels.
But what is more concerning is that we see that
the air pollution and over the years the exposure to
it can actually impact every system in the body. It's
(24:35):
not just the lungs. It can have an effect on everything,
including your brain, including conditions like diabetes. It does impact
the children as well, so there is enough research to
now suggest that you know, high air pollution levels can
lead to premature babies. It can lead to development delays
in babies. There is also some links between certain brain
(25:00):
conditions and pollution. Of course, the lungs are severely affected
with pollution. It can lead to conditions such as COPD.
There is an increase in asthma as well. There is
also an impact on heart conditions, so for example, we
know that increased level of pollution can also increase the hypertension,
(25:23):
so your blood pressure levels, it can increase, so the
control of diabetes goes down with the air pollution. There
are other systemic changes. It affects the hearts. It also
causes a lot of infections because it sort of impacts
the immunity of the body. So air pollution is not
an isolated thing which leads to just some acute symptoms.
(25:46):
It can have a chronic impact over the entire lifetime
of a person, right from the time when they are
in the womb, so it is a very very serious condition.
Speaker 1 (25:59):
And lastly, Anona, as you mentioned, we still see pollution
as a seasonal inconvenience. So what would you lay down
as your non negotiables for twenty twenty six On air pollution.
Speaker 2 (26:11):
So, of course when we talk about air pollution, the
highlight of it comes in the national capital, which sees
one of the worst air pollutions, and of course the
entire of the gangetic planes is where we see very
bad air pollution levels during these months. What is needed is,
of course there's a national clean air plan and whatever,
(26:32):
but there has to be implementation of it, like when
we talk about Deli, looking at what are the sources
of pollution, and it cannot just be the you know,
par aali burning. That's not the entire reason for the
bad air in the region. It is also the amount
of vehicular emissions that we have, the construction that we have,
(26:53):
So just you know, taking a look at what is
causing the pollution and developing a plan to bring down
the pollution levels over the years, and not a short
term plan to sort of mitigate. See the GRAP being
implemented is a very short term measure to help people
when the pollution level spike, but that is not something
(27:16):
that can take care of the actual reasons why this
becomes a problem. Every year. That has to be addressed
in a systematic plan over the years, and we need
to work on that.
Speaker 1 (27:32):
You were listening to Three Things by the Indian Express.
Today's show was edited and mixed by Savar and produced
by Shishang Hagov and me At Shasharma. If you like
the show, do subscribe to us wherever you get your podcast.
You can also recommend it to someone you think may
like it, with a friend or in your family. This
is the best way for people to get to know
about us. You can also tweet us at Express podcast
(27:55):
or write to us at podcast at Indian Express dot com.
Speaker 2 (28:00):
M
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